Decoding the Genetics of Pattern Hair Loss

Hair loss, as experienced by men and women worldwide, is often a symptom of a gradual but steady biological process. In most cases, this pattern of hair loss has a familiar appearance, usually starting at the temples or crown and eventually resulting in the loss of frontal hair in men and a gradual loss of top hair density and volume in women. This pattern of hair loss is also known as male or female pattern hair loss or androgenetic alopecia (AGA) and is characterized by a steady progression over decades of follicular miniaturization. While certain patterns of hair loss can be attributed to short-term illness or stress and will spontaneously resolve, AGA is not “random” hair loss but is a selective process that gives a very strong indication as to which hair follicles will follow their genetic blueprint for resistance to or susceptibility for miniaturization and eventual hair loss.

The Science of Hair Loss: Androgenetic Alopecia (AGA)
Male and female pattern hair loss is primarily caused by a genetic predisposition. This genetic blueprint combined with hormonal signaling (testosterone and its active metabolite dihydrotestosterone (DHT)) is the primary mechanism of AGA. Follicular miniaturization is a gradual process that usually spans decades. At a cellular level, the miniaturization process results in a shortening of the hair growth cycle and a shorter and finer hair shaft with loss of pigmentation. With each subsequent cycle, this miniaturization process gradually results in thinner, less visible hairs that eventually disappear.

Genetics and Hormones: The Role of Inheritance and Biochemistry
Genetic androgenetic alopecia is polygenic, meaning that a person inherits several small genetic variations from both their mother and father that work in combination with each other. A large proportion of inherited sensitivity is from a single gene that codes for the androgen receptor. The androgen receptor is a protein found on the surface of many cells in the body that has a specific binding affinity for certain androgens (primarily testosterone and DHT). In a hair transplant, the follicles used from the back of the scalp have a genetic blueprint that is resistant to DHT, even when transplanted to a balding area.

While the biological role of DHT is not completely understood, its action is highly pronounced in both AGA and the normal development of male genitalia. A genetic predisposition to DHT sensitivity causes the affected follicles to react to the hormone. In genetically predisposed men and women, the resulting binding of DHT to the androgen receptor on the follicle eventually leads to a shutdown of hair growth or follicular miniaturization. This process is both hereditary and can be inherited from either the mother’s or father’s side of the family.

Psychological and Social Aspects of Hair Loss: Acknowledging the Emotional Impact
Hair loss has an extremely negative impact on self-image, self-esteem and a patient’s sense of identity. The psychological impact of hair loss is frequently related to, and intertwined with, social and cultural views of self. Hair is a visible part of self-identity that is often associated with youth, beauty, vitality, and health, and patients often experience an array of negative emotions associated with the experience of hair loss including anxiety, depression, shame, and embarrassment.

Clinical Management and Treatment Strategies
Hair loss, while not reversible, is completely treatable. There is a wide range of treatment options, many of which are highly effective. Patients are encouraged to discuss their options with a qualified medical professional.

Medical and Pharmacological Interventions

Topical treatments like minoxidil are both readily available and highly effective. It is important to note that topical treatments have a “lag time” and are most effective after consistent application for three to six months. We usually recommend starting with a topical treatment regimen first in conjunction with biotin supplements. The primary drawback of topical therapy is that it must be continued indefinitely to maintain results. Oral medications like finasteride have a similar long-term maintenance requirement.

Emerging and Advanced Hair Loss Solutions

Hair loss research and treatment have both become extremely sophisticated and effective. From advanced low-level laser therapy and cosmetic stem cell treatment, to cutting-edge hair multiplication, medical solutions are both readily available and highly effective.

Hair transplantation is a very effective and practical treatment option. Donor hair will grow again if transplanted to an area with the same genetics as the back of the scalp. The procedure has become extremely safe and comfortable for patients, especially with modern Follicular Unit Extraction (FUE) techniques.

Hair Transplant Surgery: A Definitive Solution
Hair transplantation is the most permanent and natural-looking solution for hair loss, as it provides a biological and permanent solution. Hair transplantation works by transplanting healthy resistant donor hair follicles from the back of the scalp to balding or thinning areas. Transplanted follicles retain their genetic resistance, and will continue to grow even after being transplanted. The FUE technique of hair transplantation uses a small hand-held punch tool to individually harvest healthy follicles from the back of the scalp, which are then transplanted using a high-powered microscope. The technique is extremely precise, minimally invasive, and is associated with minimal post-operative discomfort. In many cases, temporary bandages or dressings can be avoided. FUE can be combined with PRP therapy, in which the patient’s own blood platelets are extracted and concentrated to stimulate growth in follicles during and after the transplantation procedure.

InvisibleEars: Pioneering Results in Hair Restoration
We are also pioneers of a revolutionary new hair restoration procedure called InvisibleEars (IE). The InvisibleEars (IE) procedure is an extremely effective hair transplantation technique where the natural front hair line is “flipped up” and the entire bald or thinning area of the scalp is filled with transplanted follicles. When the front hair line is flipped back down, the transplanted area is completely hidden, leaving only the most natural-looking and undetectable hair transplant. The InvisibleEars (IE) technique can also be applied using a partial procedure that also achieves a very natural and undetectable appearance.

Looking to the Future: Advances in Hair Loss Treatments
As understanding of hair growth and loss continues to advance, so too do our treatment options for hair loss. Research in hair stem cell biology, the basic molecular building blocks for new hair growth, has led to significant interest in the ability to directly grow new hair follicles in the laboratory from a patient’s own stem cells. Preliminary results have shown significant early promise with hair cloning.

Hair Multiplication is another exciting area of research that is well underway and shows early promise for the direct culturing of a patient’s resistant donor follicles in a laboratory setting, to later be transplanted back into the scalp.

Hair loss, specifically androgenetic alopecia (AGA), is a common condition with a well-understood biological process that has both predictable clinical appearances and a highly treatable progression. The causative mechanism of AGA is a combination of genetic inheritance and androgen signaling which ultimately results in a pattern of follicular miniaturization. The progression of AGA can be reversed, slowed or stopped, and has many safe and effective treatment options that are often a combination of medical, procedural, and supportive care treatments.

At the Powell Medical Center, we use a highly customized approach to treating hair loss that is suited to the needs, goals, and genetic factors for each patient. By addressing all aspects of the patient experience, we are able to consistently deliver superior care, results, and service.